GI Assessment, Nutritional Problem, Obesity, Cancers Flashcards
How do you palpate the liver?
- left hand on back to support right 11th & 12th ribs
- Right hand lateral to RUQ
- patient takes deep breath
- should feel firm, sharp, & smooth
- withdrawal pain = inflammation
Liver Biopsy Preop
- VS
- withhold food for 8-12 hrs
- check coagulation status
- sedative
- obtain type & crossmatch
- patient teaching & consent
Liver Biopsy Post Op
- VS for internal bleeding
- notify of dyspnea & cyanosis (pneumothorax)
- keep patient lying on right side for minimum of 2 hrs
- bed rest 12-14 hrs
Enteral Nutrition Complications
- clogged tube
- improper positioning
- aspiration
Parenteral Tube Complications
- refeeding syndrome
- infection & septicemia
- changes in pulmonary status
What is refeeding syndrome characterized by?
- fluid retention
- electrolyte imbalances
- hyperglycemia
Malnutrition Planning
- achieve appropriate weight
- consume a certain # of calories per day
- no adverse consequences r/t malnutrition or nutritional therapies
Restrictive Bariatric Surgery
reduces either the size of the stomach or the amount allowed to enter the stomach
Adjustable Gastric Banding
uses a band to create a gastric pouch
Sleeve Gastrectomy (SG)
creates a sleeve-shaped stomach by removing about 75%
Biliopancreatic diversion with duodenal switch
creates an anastomosis between the stomach & the intestine
Roux-en-Y gastric bypass
constructs a gastric pouch whose outlet is a Y-shaped limb of the small intestines
Assistive Devices for obesity
- electronic stethoscopes
- pulse oximetry
Bariatric Surgery Preop
- patient understands surgery & is away of possible catheters, IVs, & SCDs
- emphasize VS will often be checked
- will be assisted with ambulation
- deep breathing & coughing practice
- liquids started early when patient is awake
Bariatric Surgery Post Op
- VS
- stabilize airway
- observe drainage, incision, & infection signs
- elevate head 35-45 degrees
- water and sugar free clear liquids
Why are obese patients at risk for re-sedation?
anesthetics are stored in adipose tissue
Bariatric Surgery: Home Care
- high protein liquid diet
- eat slowly & stop eating when full
- no liquids with solids
- vomiting is common
- weight loss happens in 6-12 months
Why must a possible pregnancy be addressed with a female patient after bariatric surgery?
- pregnancy complications can result from anemia & nutritional deficiency
- one result of bariatric surgery is the return of fertility
- postpone 12-18 months
Metabolic Syndrome Criteria
3/5 of criteria
- elevated waist circumference (> 35 women; > 40 men)
- triglycerides > 150
- HDL < 40
- HTN (systolic > 130 or diastolic > 85)
- fasting glucose > 100
Lifestyle Modifications for Metabolic Syndrome
- diet low in saturated fats
- diet to promote weight loss
- stop smoking
- increase regular physical activity
Oral Cancer
mouth and throat
- more common in males
- after 35 yrs old
Esophageal Cancer Findings
- pain with eating
- choking
- hoarseness/cough
- anorexia/weight loss
- regurgitation
Stomach cancer risk factors
- H. pylori infection
- pernicious anemia
- achlorhydria
- family history
Colorectal Cancer risks
- tobacco use & diet high in fat/calories
- 1st degree relative
- > 50 yrs old
- African Americans
- IBD history & adenomatous polyps
Ostomies
surgically created opening on the surface of the body
- ileostomy liquid stools
- ascending colostomy: semi liquid stools
- transverse colostomy: semi formed stools
- sigmoid colon: formed stools
Post-op stoma assessment
- every 4 hrs
- mild to moderate edema
- small amount of bleeding & oozing
Stoma Colors
- Red: good, postop
- Pale: anemia
- Dark red-purple: ischemia; inadequate blood supply
- Brown-black: necrosis
When should you change your ostomy?
no set time
-usually daily
Ostomy Surgery Evaluations
- minimal alteration in bowel eliminations
- optimal nutrition
- relief of pain
Gallbladder Cancer Interventions
- nutrition
- hydration
- skin care
- pain management
